Specimen rejection in laboratory medicine: Necessary for patient safety?

Introduction

The emergency laboratory in Hacettepe University Hospitals receives specimens from emergency departments (EDs), inpatient services and intensive care units (ICUs). The samples are accepted according to the rejection criteria of the laboratory. In this study, we aimed to evaluate the sample rejection ratios according to the types of pre-preanalytical errors and collection areas.

Materials and methods

The samples sent to the emergency laboratory were recorded during 12 months between January to December, 2013 in which 453,171 samples were received and 27,067 specimens were rejected.

Results

Rejection ratios was 2.5% for biochemistry tests, 3.2% for complete blood count (CBC), 9.8% for blood gases, 9.2% for urine analysis, 13.3% for coagulation tests, 12.8% for therapeutic drug monitoring, 3.5% for cardiac markers and 12% for hormone tests. The most frequent rejection reasons were fibrin clots (28%) and inadequate volume (9%) for biochemical tests. Clotted samples (35%) and inadequate volume (13%) were the major causes for coagulation tests, blood gas analyses and CBC. The ratio of rejected specimens was higher in the EDs (40%) compared to ICUs (30%) and inpatient services (28%). The highest rejection ratio was observed in neurology ICU (14%) among the ICUs and internal medicine inpatient service (10%) within inpatient clinics.

Conclusions

We detected an overall specimen rejection rate of 6% in emergency laboratory. By documentation of rejected samples and periodic training of healthcare personnel, we expect to decrease sample rejection ratios below 2%, improve total quality management of the emergency laboratory and promote patient safety.Key words: clinical laboratory services, total quality management, patient safety, preanalytical phase, preanalytical error     

Free DNA – new potential analyte in clinical laboratory diagnostics?

The existence of cell free DNA in the human circulatory system has been known since the 1950s, however, intensive research in this area has been conducted for the last ten years. This review paper brings a short overview of the existing literature concerning the cell free DNA research in various clinical fields and pathological states and considers the application possibilities of this new analyte in clinical laboratory diagnostics. At the moment, cell free DNA is most widely used for the purpose of non-invasive prenatal diagnosis of fetal sex or fetal RhD status. The recent discovery of epigenetic changes in placental/fetal DNA and the detection of fetal/placental-specific RNAs have made it possible to use this technology in all pregnancies irrespective of the gender of the fetus. With the application of new techniques such as next generation sequencing, digital PCR and mass spectrometry, it is now possible to detect very small amounts of specific DNA in the presence of excess of other nonspecific nucleic acids. Second most probable application is in oncology, where detection and monitoring of tumors is now possible by the detection of tumor-derived nucleic acids. Third promising field for near future implementation of this analyte is transplantation medicine, where free DNA level could serve as a marker of transplant rejection. Before any further utilization of this new biomarker, pre-analytical and analytical aspects of free DNA analysis remain to be standardized. In the field of noninvasive prenatal diagnosis, important ethical, legal and social questions remain to be discussed.     

AAEE – Automated evaluation of students’ essays in Arabic language

Assessing student’s essay writing and providing thoughtful feedback is a truly labor-intensive and time-consuming task. With human instructors already overwhelmed, the alternate is to consider a computer-based grading. Recent advances have generated renewed interest in automatic evaluation of essays (AEE). The AEEs instantaneous feedback and more consistent grading helps students draft better essays. This work presents a system to automatically grade the school children essays in Arabic, calling it AAEE for “automatic Arabic essays evaluator”. The system is modeled upon the scoring scheme followed by the school instructors in Saudi Arabia. The instructors had specific criteria upon which an essay is assessed. Putting these criteria together we developed a system that relies on Latent Semantic Analysis, and Rhetorical Structure Theory. With this design we are able to assess individual components of the essay such as language proficiency, structure of the essay etc. To test the system, we collected essays by local school children covering grades 7–12. A total of 350 different handwritten essays—spanning eight different topics—each transcribed into computer readable format. The AAEE shows that 90% of the test essays were correctly scored, and a correlation of 0.756 between automatic and teachers’ scoring. This exceeds the human-human correlation of 0.709 for the Arabic essays.     

Reversible atransferrinemia in a patient with chronic enteropathy: is transferrin mandatory for iron transport?

Herein, we report the case of a 42-year-old woman, hospitalized in a French tertiary hospital for a relapse of a chronic enteropathy, who was found on admission to have no detectable serum transferrin. Surprisingly, she only exhibited mild anaemia. This atransferrinemia persisted for two months throughout her hospitalization, during which her haemoglobin concentration remained broadly stable. Based on her clinical history and evolution, we concluded to an acquired atransferrinemia secondary to chronic undernutrition, inflammation and liver failure. We discuss the investigations performed in this patient, and hypotheses regarding the relative stability of her haemoglobin concentration despite the absence of detectable transferrin.     

Is an integrative laboratory algorithm more effective in detecting alpha-1-antitrypsin deficiency in patients with premature chronic obstructive pulmonary disease than AAT concentration based screening approach?

Introduction:

Alpha-1-antitrypsin deficiency (AATD), genetic risk factor for premature chronic obstructive pulmonary disease (COPD), often remains undetected. The aim of our study was to analyse the effectiveness of an integrative laboratory algorithm for AATD detection in patients diagnosed with COPD by the age of 45 years, in comparison with the screening approach based on AAT concentration measurement alone.

Subjects and methods:

50 unrelated patients (28 males/22 females, age 52 (24–75 years) diagnosed with COPD before the age of 45 years were enrolled. Immunonephelometric assay for alpha-1-antitrypsin (AAT) and PCR-reverse hybridization for Z and S allele were first-line, and isoelectric focusing and DNA sequencing (ABI Prism BigDye) were reflex tests.

Results:

AATD associated genotypes were detected in 7 patients (5 ZZ, 1 ZM_malton, 1 ZQ0_amersfoort), 10 were heterozygous carriers (8 MZ and 2 MS genotypes) and 33 were without AATD (MM genotype). Carriers and patients without AATD had comparable AAT concentrations (P = 0.125). In majority of participants (48) first line tests were sufficient to analyze AATD presence. In two remaining cases reflex tests identified rare alleles, M_malton and Q0_amersfoort, the later one being reported for the first time in Serbian population. Detection rate did not differ between algorithm and screening both for AATD (P = 0.500) and carriers (P = 0.063).

Conclusion:

There is a high prevalence of AATD affected subjects and carriers in a group of patients with premature COPD. The use of integrative laboratory algorithm does not improve the effectiveness of AATD detection in comparison with the screening based on AAT concentration alone.     

Licensing standard-essential patents in the IoT – A value chain perspective on the markets for technology

Innovative industries need efficient markets for technology (MFTs). One determinant of MFT efficiency neglected until now is licensing level—that is, the level in the value chain where patents are licensed. Patents may be licensed upstream, to firms that put the patented knowledge into practice. I refer to this as integrated licensing. Alternatively, patents may be licensed further downstream in the value chain, in particular to makers of final devices. I call this bifurcated licensing since it separates intellectual property rights from the technical knowledge they cover. I study the licensing level of essential patents on communication standards such as LTE and Wi-Fi in relation to the Internet of Things (IoT). The choice of licensing level in this context is currently a hotly debated topic. To show how bifurcated licensing affects MFT efficiency, I present empirical evidence from a qualitative study comprising interviews with 30 individuals from 22 diverse firms, focusing on startups. IoT device makers clearly find the uncertainty regarding infringement, patent validity, and the licensing process hinders efficient licensing, which is compounded by the large number of IoT device makers and, for SMEs and startups, by resource constraints. As a theory contribution, I show that a patent's licensing level need not correspond with the implementation level of the patented knowledge—in other words, licensing may be bifurcated rather than integrated. I develop a model of how licensing level affects MFT efficiency. Implications for practice are that device-level licensing of standard-essential patents (SEPs), if broadly implemented, would have a negative effect on innovation and entrepreneurship in the IoT. Policymakers should ensure that SEP licensing is simplified.     

Practicing secrecy in open innovation – The case of a military firm

In order to keep up with the pace of innovation, military firms have recently launched a series of open innovation (OI) initiatives to search for and integrate external knowledge into their internal development process. Adopting OI in such a secretive environment unlocks new possibilities to analyze how firms can pursue openness and secrecy. This article builds on a qualitative research conducted inside a large military firm that has implemented an inbound OI strategy. Relying on multiple case studies and interviews with individual players involved in the firm's OI initiatives, we analyzed how these players deploy secrecy practices when participating to OI projects. They actually combine cognitive practices (aiming at modulating the contextual depth of the knowledge revealed through reframing) with relational practices (aiming at controlling the visibility and exposure of this knowledge). We highlight how these combinations evolve during the lifecycle of OI partnerships. By emphasizing different modes by which individual actors practice secrecy in OI, we contribute to previous research addressing how organizations navigate the paradox of openness. Besides, this study proposes new theoretical insights on the role and features of secrecy practices in innovation activities, and thus contributes to the emerging research field of managerial secrecy.     

A Beamline with a Double Crystal Monochromator in Middle X-ray Range

The beamline 3B3 with adouble crystal monochro-mator in the middle X-rayrange has been successfully con-structed at the Beijing SynchrotronRadiation Facility (BSRF) under theCAS Institute of High EnergyPhysics. It was checked and ac-cepted by a panel of experts on April4 in Beijing.The beamline is an engineeringproject by integrating different high-technologies, including X-rayoptics, fine machinery, ultra-highvacuum technology, electronicsand m icr ocomputer contr otechnology. Consist…     

How compliant are technicians with universal safety measures in medical laboratories in Croatia? – A pilot study

Introduction

This pilot study aimed to investigate the use of personal protective equipment (PPE) and compliance to the code of conduct (rules defined in institutional, governmental and professional guidelines) among laboratory technicians in Croatian medical laboratories. In addition, we explored the differences in compliance between participants of different age groups, laboratory ownership and accreditation status.

Materials and methods

An anonymous and voluntary survey with 15 questions was conducted among Croatian medical laboratory technicians (N = 217). The questions were divided into two groups: demographic characteristics and the use of PPE. The questions of the second part were graded according to the Likert scale (1-4) and an overall score, shown as median and range (min-max), was calculated for each participant. Differences between the overall scores were tested for each group of participants.

Results

The majority of participants always wear protective clothes at work, 38.7% of them always wear gloves in daily routine, more than 30.0% consume food and almost half of them drink beverages at workplace. A significantly lower overall score was found for participants working in public compared to private laboratories (36 (16-40) vs. 40 (31-40), P < 0.001). There were no statistically significant differences in overall scores for participants of different age groups (P = 0.456) and laboratory accreditation status (P = 0.081).

Conclusion

A considerable percentage of laboratory technicians in Croatian medical laboratories do not comply with safety measures. Lack of compliance is observed in all personnel regardless laboratory accreditation and participants’ age. However, those working in private laboratories adhere more to the code of conduct.Key words: survey, compliance, laboratory technician, universal safety measures, total quality management, clinical laboratory services     

Assessing transitions through socio-technical configuration analysis – a methodological framework and a case study in the water sector

Classic accounts of transitions research have predominantly built on reconstructions of historical transition processes and in-depth case studies to identify and conceptualize socio-technical change. While such approaches have substantively improved our understanding of transitions, they often suffer from methodological nationalism and a lack of generalizability beyond spatial and sectoral boundaries. To address this gap, we propose a novel methodology – socio-technical configuration analysis (STCA) – to map and measure socio-technical alignment processes across time and space. STCA provides a configurational and dynamic perspective on how social and technical elements get aligned into “configurations that work”, allowing for the identification of differentiated transition trajectories at and across spatial and sectoral contexts. The methodology's value is illustrated with the empirical case of an ongoing shift from centralized to more modular infrastructure configurations in the global water sector. Building on this illustration, we outline potential contributions of STCA to configurational theorizing in transition studies, sketching the contours of what we believe could become a generative epistemological approach for this field.     

Exploring knowledge management implementation in large-sized service organizations – Saudi Arabia as a case

Whereas there is a growing literature that investigates knowledge management (KM) in service corporates, yet the overview and understanding of KM in large-sized service organisations is yet limited and sparse. Transitional economies, like of Saudi Arabia, are highly motivated to establish a knowledge based structure both economically and socially. There is an urgent need for exploring the current situation of KM tools usage and of perspectives on knowledge and knowledge management, as a start by large sized service organisations. Towards further understanding in this regard, this paper explores the status and potentials of KM implementation scoped to Saudi large-sized service organisations. The paper triangulated an interviewer-administrated questionnaire and focus groups to gather the data. The results indicate that although the weighted average of KM tools/methods deployment (being deployed or can possibly be deployed) reaches 79%; however, the written comments in front of each tool indicates that the participants’ understanding of what KM seems distorted, which is confirmed in the coding of their definitions of the term ‘Knowledge’. The participants identified leadership and strategy formulation as the top two critical success factors. A number of other results are presented and several issues were identified for future research.     

CAS Joins Hands with Local Governments in Creating a Bio-medical Research Body

CAS President Lu Yongxiang,Governor of GuangdongProvince Huang Huahuaand Mayor of Guangzhou CityZhang Guangning signed an agree-ment on July 5 to jointly establish abio-medical research institute inGuangzhou, capital of GuangdongProvince.Under the agreement, the threeparties will invest a total of 300 mil-lion yuan (or US$ 36 million) overthe next three years to develop theinstitute.Titled the CAS Guangzhou In-stitute of Biomedicine and HealthScience, it will strive to establish the…     

Content and knowledge provision service – a way to build intellectual capital in learning organizations

This paper presents the concept and the implementation of the Content and/or Knowledge Provision (CKP) service. The service is developed as a part of research within Intelligent Learning Extended Organization, an 7th Framework Program for R&D project in the area of technology-enhanced learning. The project aimed at enhancing cross-organizational Learning and Knowledge Building (LKB) practices at workplaces, leading to continuous growth of organization’s intellectual capital. By using the CKP service, employees can upload different kinds of knowledge assets into a knowledge repository, annotate them and (re-)discover relevant ones by performing semantic search over the knowledge repository. Hence, the service effectively serves as a content and knowledge-sharing facility and semantic search engine within a learning organization. Furthermore, CKP enables collaborative manipulation and annotation of knowledge assets in the repository, thus supporting all three components of intellectual capital.     

Against misleading technocratic precision in research evaluation and wider policy – A response to Franzoni and Stephan (2023), ‘uncertainty and risk-taking in science’

Franzoni and Stephan (2023) recommend a probabilistic ‘subjective expected utility’ technique for addressing challenges of uncertainty in research evaluation. Whilst acknowledging strengths in F&S's analysis, this Response highlights a series of important practical, theoretical and methodological deficiencies. The stakes are raised, in that these are widely shared in a growing body of practice across research policy and beyond. This practice seeks to reduce and aggregate real-world complex, ambiguous, qualitative, multidimensional and contested challenges through ostensibly precise calculation. Taking associated problems in turn, this Response shows how F&S: make scientifically dubious claims; understate the depths of uncertainty; overstate the sufficiency of quantification; neglect foundational limits to calculation; and ignore crucial interpretive dimensions of policy making. Highlighting roles for greater methodological diversity, this Response points at the end to alternative methods that collectively allow more robustly plural approaches to contrasting aspects of incertitude. In the process, the steering of directions for research can become more rigorous and accountable and less vulnerable to manipulation and inadvertent bias. With globally growing ‘post-truth’ authoritarian populism arguably partly provoked by the kind of technocracy criticised here, research evaluation may in a small way help re-invigorate democracy by ‘opening up’ in this particular area, the hiding of politics behind expertise.     

An empirical analysis of the IC Navigator approach in practice – a case study of five manufacturing firms

The literature surrounding Intellectual Capital (IC) theory has grown substantially over the last 10 years with new models, frameworks and approaches introduced for how to manage IC. Yet, the practical implication of deploying IC methods in an organisation and its impact on a firm's business model innovation and decision-making process is relatively unexplored. This paper will review one tool, the IC Navigator approach and its effectiveness as a tool for resource deployment analysis and its impact on a firm's future value creation activities. The paper reports on research that involved five manufacturing firms who participated in an action learning workshop series and particularly the workshop dedicated to using the IC Navigator approach. The usefulness of this model as a tool to reconfiguring a firm's resources, as perceived by the five firms, is examined and findings are presented.     

Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional,longitudinal study

Introduction:

The aim of the study was to identify biomarkers of alteration in bone mineral density (BMD) in patients on haemodialysis (HD) and peritoneal dialysis (PD).

Materials and methods:

In a cross-sectional, longitudinal study dual-energy X-ray absorptiometry scans were performed in 146 HD-patients and 28 PD-patients. Follow-up after 14 months (mean) was conducted in 73 patients. As potential biomarkers we investigated parathyroid hormone (PTH), 25-hydroxy vitamin-D, ionised calcium, albumin, phosphate, and total alkaline phosphatases (t-ALP).

Results:

Both groups of dialysis patients had lower BMD in the femoral neck (BMD_neck) (P < 0.001) and forearm (BMD_forearm) (P < 0.001) compared to healthy controls, but comparable BMD in the lumbar spine (BMD_spine). BMD did not differ between dialysis types, but patients ever-treated with glucocorticoids had significantly lower BMD, while patients with polycystic kidney disease had higher BMD. BMD correlated with body weight, actual age, age at initiation of dialysis, duration of dialysis and levels of PTH and t-ALP. However, t-ALP only remained associated with low BMD_spine after adjusting for other factors (P = 0.001). In the follow-up study all patients had decreased BMD in all three locations, but only for the lumbar spine there was a significant association between BMD and the bone markers t-ALP (P = 0.009) and PTH (P = 0.013).

Conclusions:

Both HD and PD patients have low BMD, and increased concentrations of t-ALP is associated BMD_spine after adjustment, while PTH and t-ALP is associated with decrease in BMD_spine over time. This substantiates the use of these biomarkers in both types of dialysis patients.     

Safety in unpredictable complex systems – a framework for the analysis of safety derived from the nuclear power industry

The increasing complexity and power of our technologies compels us to find new ways in which to conceptualise, understand and maintain their safety in the long term. Some complex technological industries have performed better than others in terms of applying sustained and systematic approaches to the maintenance of safety. The United States nuclear power industry can be seen as an ideal test-bed for the development of safety initiatives, being responsible for the control of potentially unpredictable technology that involves extraordinary forces and costs. This paper describes and formalises a framework for better understanding the safety of complex socio-technological systems, based on key events in the development of safety in the United States nuclear power industry. The framework comprises two components: (1) a state-space approach for better conceptualising system failures, the benefits of incident reporting and remedial safety initiatives; and (2) a set of milestones that can be used to assess the development of safety in socio-technological industries. Healthcare and the United States nuclear power industry both represent complex socio-technological systems with similar technical characteristics. However, safety strategies in healthcare have not kept pace with the increasing complexity of clinical practice, and there have been international calls for improvements in patient safety. The framework is applied to the analysis of safety in healthcare, demonstrating its utility as an alternative safety analogy in healthcare. Use of the framework indicates substantial scope for improvements in healthcare safety through major evidence-based system redesign. By lowering the threshold for the reporting of incident data to include accident precursors, it is possible to identify problem areas before patient harm occurs.